Division of Population Health Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland.
Department of Pharmacy, CIRFF, Center of Pharmacoeconomics, University of Naples Federico II, Naples, Italy.
Drugs Aging. 2021 Nov;38(11):1025-1037. doi: 10.1007/s40266-021-00898-8. Epub 2021 Oct 11.
Older patients are at increased risk of drug-drug interactions (DDIs) due to polypharmacy. Cardiovascular and central nervous system (CNS) drugs are commonly implicated in serious DDIs.
This study aimed to determine the prevalence and factors associated with potential 'severe' cardiovascular and CNS DDIs among older (≥ 70 years) community-dwellers.
This was a prospective cohort study using linked data from a national pharmacy claims database and waves 1 and 2 of The Irish LongituDinal study on Ageing (TILDA). 'Severe' cardiovascular and CNS DDIs were identified using the British National Formulary 77 and Stockley's Drug Interactions. The prevalence of 'severe' DDIs (any DDI vs. none) was calculated. Logistic regression was used to examine the association between sociodemographic, functional ability, and medication-related factors and the risk of DDI exposure between waves 1 and 2.
A total of 1466 patients were included [mean age (standard deviation) = 78 (5.5) years; female n = 795, 54.2%]. In total, 332 community-dwellers aged ≥ 70 years [22.65%, 95% confidence interval (CI) 20.58-24.86] were potentially exposed to at least one 'severe' cardiovascular or CNS DDI, with more than half (54.82%) of this cohort dispensed the same DDI for a prolonged time (≥ 3 consecutive claims). Aspirin-warfarin was the most frequently dispensed (co-prescribed) DDI (n = 34, 10.24%, 95% CI 7.39-14.00), followed by atorvastatin-clarithromycin (n = 19, 5.72%, 95% CI 3.64-8.81). Polypharmacy [≥ 10 vs. < 5 drugs, odds ratio (OR) 13.40, 95% CI 8.22-21.85] and depression (depressed vs. not, OR 2.12, 95% CI 1.34-3.34) were significantly associated with these DDIs, after multivariable adjustment.
'Severe' cardiovascular and CNS DDIs are prevalent in older community-dwellers in Ireland, and those with polypharmacy and depression are at a significantly increased risk.
由于多种药物同时使用，老年患者发生药物-药物相互作用（DDI）的风险增加。心血管和中枢神经系统（CNS）药物通常与严重的 DDI 有关。
本研究旨在确定年龄较大（≥70 岁）的社区居民中潜在“严重”心血管和 CNS DDI 的发生率和相关因素。
这是一项使用全国药房索赔数据库和爱尔兰老龄化纵向研究（TILDA）第 1 波和第 2 波的关联数据进行的前瞻性队列研究。使用英国国家处方集 77 和 Stockley 的药物相互作用来识别“严重”心血管和 CNS DDI。计算“严重”DDI（任何 DDI 与无 DDI）的发生率。使用逻辑回归检查第 1 波和第 2 波之间社会人口统计学、功能能力和药物相关因素与 DDI 暴露风险之间的关联。
共纳入 1466 例患者[平均年龄（标准差）=78（5.5）岁；女性 n=795，54.2%]。共有 332 名≥70 岁的社区居民[22.65%，95%置信区间（CI）20.58-24.86]可能接触到至少一种“严重”心血管或 CNS DDI，其中一半以上（54.82%）的患者连续开出处方（≥3 次）。阿司匹林-华法林是最常开的（共同开的）DDI（n=34，10.24%，95%CI7.39-14.00），其次是阿托伐他汀-克拉霉素（n=19，5.72%，95%CI3.64-8.81）。多药治疗[≥10 种与<5 种药物，比值比（OR）13.40，95%CI8.22-21.85]和抑郁（抑郁与非抑郁，OR2.12，95%CI1.34-3.34）在多变量调整后与这些 DDI 显著相关。
爱尔兰年龄较大的社区居民中“严重”心血管和 CNS DDI 很常见，且多药治疗和抑郁的患者风险显著增加。
